End-stage Cancer Research Articles

Exploring the Factors Related to Knowledge of Palliative Care for Patients with Terminal Cancer Among Nursing Students: A Cross-Sectional Study

Introduction: The inadequate knowledge is the main obstacle of provision of palliative care. This study attempted to examine the association between related factors and knowledge about palliative care for patients with terminal cancer among nursing students in Bangkok, Thailand. Methods: This study was cross-sectional, conducted in June 2024 at Saint Louis College, Bangkok, Thailand. Data were collected through self-administered questionnaires measuring sociodemographic characteristics. We employed the Palliative Care Quiz for Nursing (PCQN) and the Frommelt Attitude Toward Care of the Dying (FATCOD), form B. Descriptive statistics and multiple linear regression were selected to use for analysis. Results: The participants were 111 third-year nursing students. The mean score of knowledge about palliative care for patients with terminal cancer was 8.52 (SD = 1.84. The significant predictors of knowledge about palliative care for patient with terminal cancer were experience of losing close relatives or beloved ones from cancer within 1 year (β = 1.083, p < 0.05), and attitude toward dying (β = 0.041, p < 0.05). Conclusion: This study highlights that nursing students had insufficient palliative care knowledge for patient with end-stage cancer. These findings implies that better attitude toward caring for end-of-life patient associated with improved palliative care knowledge. Therefore, to develop educational program of palliative care for nursing students with psychological and spiritual care training should be embedded in the program for optimum palliative care for patients with terminal cancer.

Effective prevention in clinical practice may save human capital loss: Real-world evidence from Taiwan's National Health Insurance

Background/PurposeEffective prevention could protect the health of the workforce, save human capital loss, and maintain employee productivity as well as economic growth. MethodsUsing real-world data of patients with end-stage kidney disease (ESKD) and lung cancer, we multiplied their lifetime survival functions with employment ratios and working salaries to estimate the lifetime employment durations and earnings. They were compared with corresponding age-, sex-, and calendar year-matched referents to assess the differences in loss of lifetime employment duration and earnings. From 2000 to 2017, 83,358 patients with end-stage kidney disease (ESKD) were associated with 32–66% lifetime productivity losses. Similarly, we collected 24,904 incident cases of lung adenocarcinoma during 2011–2018 and estimated the potential savings in human capital due to early detection. Based on the evolving trends of ESKD incidence rates in Taiwan, we calculated the lifetime human capital losses of ESKD patients in GDP (gross domestic product) percentages during 2000–2020. ResultsThe aggregate lifetime productivity losses of ESKD in terms of GDP% varied between 0.000398% and 0.01% for male patients and between 0.0001% and 0.009% for female patients. The younger the patients, the bigger the losses in GDP%. Similarly, early detection of lung adenocarcinoma saved lives and productivity to some extent. ConclusionsSuccessful prevention of catastrophic illnesses at early stages would save the lifetime employment duration and productivity of the workforce. Future reform on the NHI could consider closer coordination between public health and healthcare organizations, focusing on effective prevention of diseases and complications to save productivity loss.

Therapeutic efficacy and in vivo distribution of human umbilical cord-derived mesenchymal stem cell spheroids transplanted via B-Ultrasound-guided percutaneous portal vein puncture in rhesus monkey models of liver fibrosis

BackgroundLiver fibrosis can progress to end-stage cirrhosis and liver cancer. Mesenchymal stem cells (MSCs) were considered the most promising therapeutic strategy, but most of the MSCs injected intravenously traditionally are trapped in the lungs, rapidly reducing their survival ability. MSC spheroids cultured in 3D have shown higher tolerance to fluid shear stress and better survival than dissociated MSCs. Simulating the route of orthotopic liver transplantation, transplanting MSC spheroids into the liver via hepatic portal vein may impact superior therapeutic effects.MethodsIn the present study, human umbilical cord-derived MSC spheroids (hUC-MSCsp) were transplanted into rhesus monkey models of liver fibrosis via B-ultrasound-guided percutaneous portal vein puncture with minimized body invasion. The therapeutic effect is evaluated through hematology, ultrasound, and pathology. To study the effect of hUC-MSCsp on gene expression in rhesus monkeys with liver injury, transcriptome sequencing analysis was performed on the livers of rhesus monkeys. The distribution of transplanted hUC-MSCsp was traced with RNA scope technology.ResultsWe found that hUC-MSCsp significantly restored liver function, including ALT, AST, ALB, GLOB and bilirubin. hUC-MSCsp also significantly reduced liver collagen deposition and inflammatory infiltration, and promote dismission of liver ascites. Subsequently, the therapeutic effects were further validated in TGF-β1/Smad pathway by global transcription profile. The distribution of transplanted hUC-MSCsp were also tracked, and we found that hUC-MSCsp distributed in the liver in a sphere status at 1 h after transplantation. After 16 days, the hUC-MSCsp were dispersed into dissociated cells that were predominantly distributed in the spleen, and a significant number of dissociated cells were still present in the liver.ConclusionsThis study reveals the distributions of transplanted hUC-MSCsp after liver portal vein transplantation, and provides a novel approach and new insights into the molecular events of potential molecular events underlying the treatment of liver fibrosis with hUC-MSCsp.

Comparison of quality-adjusted life years (QALYs) of end-stage patients with gastrointestinal cancers receiving conventional therapies with recipients of supportive-palliative care package.

This study aimed to compare the quality-adjusted life years (QALYs) of patients with gastrointestinal (GI) cancer after receiving palliative and supportive care. Conducted at Firoozgar Hospital in Tehran, Iran, this observational study included 500 end-stage gastrointestinal cancer patients. The study divided these patients into two groups: 250 utilized palliative medicine services, while the remaining 250 did not. The study compared the conditions of patients in both groups. Among those receiving palliative care, only 21% underwent chemotherapy, significantly lower than the 55% in the non-palliative care group (P < 0.001). Hospital mortality rates were considerably reduced in the palliative care group, with 115 patients (46%) compared to 200 patients (80%) in the non-palliative group (P < 0.001). The average hospital stay for patients receiving palliative care was 25.11 ± 5.12 days, significantly shorter than the 96.42 ± 14.15 days in the non-palliative group (P < 0.001). The EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire scores showed that patients in the palliative care group experienced significantly better outcomes in pain and mood symptoms, but no significant difference was observed in physical function compared to the non-palliative group. Palliative medicine is recommended for gastrointestinal cancer patients as it can significantly reduce unnecessary hospital referrals and length of hospitalization.

Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: ‘Progress toward hepatitis B elimination in Canada’

Hepatitis B virus (HBV) infection affects &gt;290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a &gt;90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.

Using ChatGPT as a grief counseling tool in end-stage cancer diagnosis

With the advent of Artificial Intelligence, the healthcare system around the world has a golden opportunity to improve the quality of care and efficiently enforce the management of patients. It is the need of the hour to explore and learn what AI, and by extension, the Large Language Models like ChatGPT, can do to make the process of healing a better experience.

Immunological mechanisms in steatotic liver diseases: An overview and clinical perspectives.

Steatotic liver diseases (SLD) are the principal worldwide cause of cirrhosis and end-stage liver cancer, affecting nearly a quarter of the global population. SLD includes metabolic dysfunction-associated alcoholic liver disease (MetALD) and metabolic dysfunction-associated steatotic liver disease (MASLD), resulting in asymptomatic liver steatosis, fibrosis, cirrhosis and associated complications. The immune processes include gut dysbiosis, adipose-liver organ crosstalk, hepatocyte death and immune cell-mediated inflammatory processes. Notably, various immune cells such as B cells, plasma cells, dendritic cells, conventional CD4+ and CD8+ T cells, innate-like T cells, platelets, neutrophils and macrophages play vital roles in the development of MetALD and MASLD. Immunological modulations targeting hepatocyte death, inflammatory reactions and gut microbiome include N-acetylcysteine, selonsertib, F-652, prednisone, pentoxifylline, anakinra, JKB-121, HA35, obeticholic acid, probiotics, prebiotics, antibiotics and FMT. Understanding the immunological mechanisms underlying in SLD is crucial for advancing clinical therapeutic strategies.

Seven-Year Experience of Intramural Surgery in the Middle East: A Safety and Feasibility Analysis.

Background: Intramural surgery techniques, particularly esophageal peroral endoscopic myotomy (E-POEM), gastric peroral endoscopic myotomy (G-POEM), and peroral endoscopic myotomy for Zenker's (Z-POEM), have emerged as forefront minimally invasive endoscopic procedures. While several studies have reported on the outcomes in North America and Asia, evidence in the Middle East and North Africa remains limited. This study aims to evaluate the feasibility and safety of intramural surgery techniques within this region. Methods: This retrospective cohort study was conducted with approval from the institutional review board. All patients who underwent esophageal peroral endoscopic myotomy, gastric peroral endoscopic myotomy, and peroral endoscopic myotomy for Zenker's from January 2016 to August 2023 were included. Results: In total, 119 patients underwent intramural surgery procedures during this period. The esophageal peroral endoscopic myotomy group had 81 (68%) patients, the gastric peroral endoscopic myotomy had 34 (28.6%) patients, and the peroral endoscopic myotomy for Zenker's had 4 (3.4%) patients. The full cohort was 48.7% female, with a mean overall age of 40.5 years. The mean overall body mass index was 27.5 kg/m2. The chief complaint was dysphagia (n = 80, 67.2%). All cases were successfully completed endoscopically. During the first 30 days, the most common complications were nausea/vomiting requiring admission (n = 4, 4.76%) and pneumomediastinum (n = 2, 2.38%). At a follow-up of 19 months, there were four mortalities; the causes of death were cardiac arrest (three cases) and end-stage prostate cancer (one case). Conclusions: Intramural surgery techniques are safe and technically feasible with low complication rates. Our study suggests that clinical success in the Middle East and Northern Africa population is comparable to larger international series.

Differences in code status practice patterns among emergency clinicians working in Japan and the United States

ObjectiveThis study aimed to examine self-reported code-status practice patterns among emergency clinicians from Japan and the U.S. MethodsA cross-sectional questionnaire was distributed to emergency clinicians from one academic medical center and four general hospitals in Japan and two academic medical centers in the U.S. The questionnaire was based on a hypothetical case involving a critically ill patient with end-stage lung cancer. The questionnaire items assessed whether respondent clinicians would be likely to pose questions to patients about their preferences for medical procedures and their values and goals. ResultsA total of 176 emergency clinicians from Japan and the U.S participated. After adjusting for participants’ backgrounds, emergency clinicians in Japan were less likely to pose procedure-based questions than those in the U.S. Conversely, emergency clinicians in Japan showed a statistically higher likelihood of asking 10 out of 12 value-based questions. ConclusionSignificant differences were found between emergency clinicians in Japan and the U.S. in their reported practices on posing procedure-based and patient value-based questions. Practice implicationsSerious illness communication training based in the U.S. must be adapted to the Japanese context, considering the cultural characteristics and practical responsibilities of Japanese emergency clinicians.

Self-Management Using eHealth Technologies for Liver Transplant Recipients: Scoping Review.

Liver transplantation has become increasingly common as a last-resort treatment for end-stage liver diseases and liver cancer, with continually improving success rates and long-term survival rates. Nevertheless, liver transplant recipients face lifelong challenges in self-management, including immunosuppressant therapy, lifestyle adjustments, and navigating complex health care systems. eHealth technologies hold the potential to aid and optimize self-management outcomes, but their adoption has been slow in this population due to the complexity of post-liver transplant management. This study aims to examine the use of eHealth technologies in supporting self-management for liver transplant recipients and identify their benefits and challenges to suggest areas for further research. Following the Arksey and O'Malley methodology for scoping reviews, we conducted a systematic search of 5 electronic databases: PubMed, CINAHL, Embase, PsycINFO, and Web of Science. We included studies that (1) examined or implemented eHealth-based self-management, (2) included liver transplant recipients aged ≥18 years, and (3) were published in a peer-reviewed journal. We excluded studies that (1) were case reports, conference abstracts, editorials, or letters; (2) did not focus on the posttransplantation phase; (3) did not focus on self-management; and (4) did not incorporate the concept of eHealth or used technology solely for data collection. The quality of the selected eHealth interventions was evaluated using (1) the Template for Intervention Description and Replication guidelines and checklist and (2) the 5 core self-management skills identified by Lorig and Holman. Of 1461 articles, 15 (1.03%) studies were included in the final analysis. Our findings indicate that eHealth-based self-management strategies for adult liver transplant recipients primarily address lifestyle management, medication adherence, and remote monitoring, highlighting a notable gap in alcohol relapse interventions. The studies used diverse technologies, including mobile apps, videoconferencing, and telehealth platforms, but showed limited integration of decision-making or resource use skills essential for comprehensive self-management. The reviewed studies highlighted the potential of eHealth in enhancing individualized health care, but only a few included collaborative features such as 2-way communication or tailored goal setting. While adherence and feasibility were generally high in many interventions, their effectiveness varied due to diverse methodologies and outcome measures. This scoping review maps the current literature on eHealth-based self-management support for liver transplant recipients, assessing its potential and challenges. Future studies should focus on developing predictive models and personalized eHealth interventions rooted in patient-generated data, incorporating digital human-to-human interactions to effectively address the complex needs of liver transplant recipients. This review emphasizes the need for future eHealth self-management research to address the digital divide, especially with the aging liver transplant recipient population, and ensure more inclusive studies across diverse ethnicities and regions.

Peningkatan Leukosit, Neutrofil, dan Prokalsitonin Persisten Tanpa Bukti Infeksi pada Kanker Stadium Akhir: Sebuah Laporan Kasus

Elevation of leukocyte, neutrophil, and procalcitonin (PCT) has been known as a marker of bacterial infection independent of the underlying disease. This article will describe a case of end-stage cancer with persistent elevation of leukocyte, neutrophil, and procalcitonin with no evidence of infection. A 45-year-old female presented with abdominal distension for three months prior to hospital admission. The patient was suspected to have breast cancer with hepatic metastasis based on diagnostic tests. Throughout treatment, the patient experienced persistent elevation of leukocytes, neutrophils, and PCT despite no signs or symptoms of infection from history, physical examination, and diagnostic tests. The patient received antibiotic therapy including ciprofloxacin escalated to meropenem, but leukocytes, neutrophils, and PCT did not decrease. A breast tumor biopsy was performed. The result of biopsy revealed after the patient had passed away. The histopathology was invasive carcinoma, No Special Type (NST) of right breast. The immunohistochemistry showed luminal B type, HER2 positive. The persistent increase in leukocytes and neutrophils in this patient indicates poor prognosis, disease progression, metastasis, and pro-cancer activity of neutrophils. The elevated PCT in this patient may be due to systemic inflammation and/or aberrant secretion from the cancer itself.

Spiritual Needs of Patients with End-stage Cancer; an Exploratory Description through Nurses’ Lens

Spiritual Needs of Patients with End-stage Cancer; an Exploratory Description through Nurses’ Lens

Evaluating end-stage cancer patients' preferences for spending their final days at home or in hospital

Introduction: This study aimed to explore the preferences of end-stage cancer patients regarding spending their final days at home or in a hospital, focusing on the impact of cancer types and symptoms necessitating palliative care admission during this period. Methods: The study was conducted with 274 patients diagnosed with end-stage cancer and admitted to the palliative service of Dr. İFC City Hospital in Tekirdağ province. Opinions were collected from all patients while they were fully conscious. The relationships between patients' preferences for their place of death and their age, gender, socioeconomic status, duration of stay in palliative care, admission complaints, and diagnoses were examined. A significance level of p&amp;lt;0.05 was considered statistically meaningful. Results: Approximately one-third of the participating patients preferred to die at home under home care supervision. It was found that these preferences were not influenced by the patients' age, gender, socioeconomic status, or duration of stay in palliative care but were affected by their cancer diagnoses and symptoms leading to admission. Patients with pancreatic cancer preferred to die in the hospital, while those with prostate and breast cancer were more likely to choose home death. Conclusion: If a system equipped with an effective planned home care program, managed by a multidisciplinary team in palliative care services, can be provided to meet the needs of patients and caregivers when they approach hospitals in their final stages, it could enable the right group of patients to spend their end-of-life at home, in accordance with their preferences.

Qualitative study on the perception of good death in patients with end-stage cancer in oncology nurses

ObjectiveTo explore the perception of good death of patients with end-stage cancer by nurses in the oncology department.MethodIn the study we used a phenomenological approach and semi-structured interviews. A total of 11 nurses from the oncology department of a Grade A hospital in Taizhou were interviewed on the cognition of good death from July 1 to September 30, 2022. Colaizzi’s analysis method was used to analyse the interview data. This study followed the consolidated criteria for reporting qualitative research (COREQ).ResultFour themes were identified: a strong sense of responsibility and mission; To sustain hope and faith; The important role of family members; Improve patients’ quality of life.ConclusionThe nurses in the department of oncology have a low level of knowledge about the “good death”, and the correct understanding and view of the “good death” is the premise of the realization of " good death”. The ability of nursing staff to improve the “good death”, attention, and meet the needs and wishes of individuals and families, is the guarantee of the realization of “good death”.

End-of-life care needs in cancer patients: a qualitative study of patient and family experiences

BackgroundCancer is a disease that transcends what is purely medical, profoundly affecting the day-to-day life of both patients and family members. Previous research has shown that the consequences of cancer are greatly aggravated in patients at the end of life, at a time when they must also grapple with numerous unmet needs. The main objective of this study was to obtain more in-depth insight into these needs, primarily in patients with end-stage cancer nearing death.MethodsSemi-structured interviews were conducted in Spain with cancer patients at the end of life (n = 3) and their family members (n = 12). The findings from the interviews were analyzed using qualitative thematic analysis and a grounded theory approach.ResultsFour major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4), needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance.ConclusionsA lack of support, information and transparency during a period of immense vulnerability makes the end-of-life experience even more difficult for patients with cancer. Our findings highlight the importance of developing a more in-depth understanding of the needs of this population, so that informed efforts can be made to improve palliative healthcare and implement more comprehensive care and support at the end of life.

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BackgroundThis study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.MethodsA longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21). Results: Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.ConclusionsOverall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Quantification of treatment-related time toxicity in patients with advanced stage cancer.

12137 Background: Treatment-related Time Toxicity (TrTT) in cancer patients is a recently proposed metric to describe the burden of time spent in pursuing medical care, including office/hospital visits, side effect management, lab tests, imaging scans, and travel time. Time toxicity is a valuable concept in patient-centered shared-decision making, especially in the palliative management of end-stage cancer patients with limited life expectancy. Despite tremendous progress in cancer treatment, most of the guideline-recommended treatment options convey short survival benefits of around 3-6 months when compared to supportive care. While medication toxicities are meticulously reviewed with patients, the cumulative burden and impact of time are rarely included in the discussion, partly due to the lack of standardized measurement of TrTT, and the absence of data from clinical trials. Thus, there is a compelling need for the quantification of time toxicity to guide clinical practice and patient preference. Methods: This was an observational analysis of the time toxicity from palliative treatment for patients with incurable solid tumors at a regional safety-net oncology office that focuses on underserved communities. Time toxicity is calculated as the number of days a patient spent with any healthcare-related encounters during a 3-month period from our medical record system. Results: The median age of the total 94 included patients was 57. 54% of the population were Hispanic. The ratios for mild, moderate, and severe time toxicity were 38%, 44%, and 18%, respectively. Immunotherapy was associated with significantly less time toxicity (TrTT = 8.5 days, 95% CI = 6.3-9.7) compared to chemotherapy (26.3 days, 95% CI = 18.3-34.4, P &lt; 0.001), while targeted therapy (13.4, 95% CI = 7.0-19.8, P = 0.01) and hormone therapy (11.9, 95% CI = 4.1-19.7, P &lt; 0.01) also has lower TrTT than chemotherapy. Patients with a worse performance status (ECOG PS 3-4, 30.1 days, 95% CI = 18.3-41.9) experienced higher time toxicity than fitter patients (PS 0-2, 16.7 days, 95% CI = 13.2-20.2, P &lt; 0.05). Among different cancer types, gastrointestinal malignancies were associated with the highest time toxicity with average TrTT of 30.2 days/3 months (95% CI =22.5-37.2). Conclusions: This is the first comprehensive study to quantify real-world Treatment-Related Time Toxicity across multiple cancer and therapy types in an underserved population. We found 18% of patients with incurable solid malignancies experienced severe time toxicity (&gt; 1 in 3 days). Higher TrTT was associated with cytotoxic chemotherapies, GI malignancies, and poor performance status. Time toxicity should be taken into account with other quality-of-life outcomes in treatment pathways and patient-centered oncology care.

High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan.

Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid availability remains extremely low in Japan. We investigated whether pain is appropriately controlled by low-dose opioid prescriptions in patients with advanced cancer in Japan. A web-based nationwide survey for caregivers from 2000 community comprehensive support care centers was performed in Japan to assess details about pain in the 30 days before patients died of end-stage cancer. Separately, the data for opioid prescription doses and medical services in the 90 days before the death of patients with cancer were extracted from a health insurance claim database. Responses from 1034 responders were retrieved and 665 patients were included. In total, 254 patients (38.2%) complained of severe-to-intolerable cancer-related pain. The median cumulative prescription dose of opioids in the 90 days before patient death was 311.0 mg by oral morphine equivalent doses. Multiple regression analyses across prefectures revealed that the proportion of patients with severe-to-intolerable cancer-related pain was negatively associated with the cumulative opioid consumption expressed as morphine-equivalent doses within 90 days before death. The very low availability of opioids for patients with end-stage cancer could result in high rate of severe-to-intolerable cancer-related pain patients. There were several limitations in this study, and the interpretations of the findings should be carefully. However, the increase in the absolute dose of opioids could improve the palliative care framework to the pain control levels of the global standard.

Future of factor XI inhibitors in cardiovascular practice.

Anticoagulation is indicated for treatment and prevention of arterial and venous thrombosis. Targeting different steps of the coagulation process, currently available anticoagulants entail an increased risk of bleeding, which detrimentally impacts on prognosis and hinders the administration of an effective antithrombotic regimen. Factor XI (FXI) inhibition has emerged as a strategy to uncouple prevention of thrombosis from bleeding. Indeed, while FXI is crucial for the amplification phase in pathological thrombosis, it is ancillary in physiological hemostasis. A comprehensive search in several scientific databases has been performed to identify relevant studies in the field. In addition, ongoing trials have been searched for in proper datasets to provide an updated and comprehensive assessment of the current state of investigations on FXI inhibition. Many compounds have been tested to inhibit FXI at different stages (i.e., synthesis, activation, or interactions with target molecules and coagulation factors). These include antisense oligonucleotides, monoclonal antibodies, small molecules, natural peptides and aptamers. In phase 2 studies, FXI inhibitors reduced thrombotic complications without any corresponding increase in bleeding. FXI inhibitors were noninferior and potentially superior to low-molecular-weight heparin in orthopedic surgery and reduced bleeding compared to apixaban in patients with atrial fibrillation. FXI inhibition is also under testing in other conditions, including end-stage renal disease, cancer, or noncardioembolic stroke. FXI inhibition represents a promising and rapidly emerging approach for a number of clinical indications. This article reviews the rationale, evidence, pharmacology, and future applications of FXI inhibition.

Therapeutic Effect of Music Therapy on Patients with End-stage Cancer: A Retrospective Study.

The aim of this study was to retrospectively analyze the effect of music therapy on patients with end-stage cancer in hospice care. This retrospective cohort study included 195 patients with end-stage cancer from January 2021 to December 2023. The conventional group comprised patients who received routine hospice care, whereas the combination group comprised those who received routine hospice care and music therapy. The immune indicators, anxiety and depression scores, quality of life scores, and sleep quality scores of both groups were compared before and after management. Before management, no significant differences were observed in the immune indicators, anxiety and depression scores, quality of life scores, and sleep quality scores between both groups (P > 0.05). However, after management, the immune indicators lymphocytes CD3+ and CD4+ were significantly higher in the combination group than in the conventional group (P < 0.05); in contrast, anxiety and depression and the Pittsburgh Sleep Quality Index scores were lower in the combination group than in the conventional group (P < 0.05). Lastly, the World Health Organization Quality of Life Brief Version scores were significantly higher in all domains in the combination group than in those in the conventional group; furthermore, the degree of decline in the physical, psychological, and social relationship domain scores was smaller in the combination group than in the conventional group (P < 0.05). For patients with end-stage cancer, music therapy can improve their immune status, quality of life, and sleep and ameliorate their anxiety and depression.